FORM 1023-EZ for SOUTH JEFF BACKPACK PROGRAM INC

Field Data
EIN 81-4368234
Case Number EO-2016326-000056
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SOUTH JEFF BACKPACK PROGRAM INC
Organization’s Mailing Address 12537 COUNTY ROUTE 155
City ADAMS CENTER
State NY
ZIP 13606
Accounting period End 12
Primary contact name FRED MORRIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

FRED MORRIS
DIRECTOR
12537 COUNTY ROUTE 155
ADAMS CENTER NY 13606

Officer/Director/Trustee Two

CYNTHIA OVERTON
DIRECTOR
23403 COUNTY ROUTE 189
LORRAINE NY 13659

Officer/Director/Trustee Three

DONNA STEVENS
DIRECTOR
15347 FULLER ROAD
ADAMS CENTER NY 13606

Organization’s website N/A
Organization’s email SJBACKPACK@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/2/2016
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K30 - Food Service, Free Food Distribution Programs
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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